Cancer, Venous Thromboembolism
Conditions
Keywords
Occult cancer, Venous thromboembolism, Biomarkers, Early diagnosis, Neutrophil extracellular traps
Brief summary
Venous thromboembolism is a common and serious complication in cancer, and is associated with a substantially increased morbidity and mortality. Furthermore, VTE may be the earliest sign of cancer. Recent studies, however, fail to show a clinical benefit of extended cancer screening in this patient population. Better risk prediction models are therefore warranted to identify VTE patients who would benefit from a rapid and extensive cancer screening. Inflammation and hypercoagulability are considered hallmarks of cancer, and emerging light is being shed on the potential of various markers of inflammation and coagulation in cancer diagnostics and prognostics. Among the inflammatory and thrombotic processes linked to cancer is the neutrophil release of web-like nuclear chromatin (DNA and histones), referred to as neutrophil extracellular traps (NETs). Driven by the tumor environment, NETs have recently been shown to play a central role in tumor progression, metastasis, and tumor-associated thrombosis. The investigators hypothesize that an enhanced inflammatory state may be predictive of an underlying cancer in patients presenting with VTE. The present study is an ongoing prospective study with the primary aim to investigate the diagnostic potential of markers of inflammation, including markers of NETs, in detecting occult cancer in patients presenting with VTE. Secondary aims are to include other biomarkers of cancer, and to assess whether any or a combination of these biomarkers may be prognostic of occult cancer, recurrent thrombotic events, mortality, or cancer disease progression in VTE patients with an underlying malignancy.
Interventions
None listed
Sponsors
Karolinska Institutet
Danderyd Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Venous thromboembolism (thrombosis in the deep venous system of upper or lower extremities or iliac veins and/or pulmonary embolism) as detected by ultrasonography, phlebography, computer tomography, or angiography; * \> 18 years or older; * Written informed consent
Exclusion criteria
* \> 2 days after VTE diagnosis; * No blood withdrawal at baseline
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cancer | Within 2 years from study inclusion | Patients diagnosed with VTE will be referred for a limited cancer screening according to current guidelines. Cancer diagnosis - if not present at inclusion - will be obtained during a two-year follow-up from hospital records and/or the Swedish cancer registry |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Recurrent thrombotic event | Within 2 years from study inclusion | Recurrent thrombotic event (arterial or venous thrombosis) will be obtained during a two-year follow-up from hospital records and/or the Swedish national patient registry |
| All-cause mortality | Within 2 years from study inclusion | All-cause mortality will be obtained during a two-year follow-up from hospital records and/or the Swedish death registry |
| Cancer progression among enrolled patients with a cancer diagnosis at study inclusion | Within 2 years from study inclusion | Patients with cancer progression will be identified during a two-year follow-up from hospital records and/or the Swedish cancer registry |
Countries
Sweden
Contacts
Primary ContactCharlotte Thålin, M.D., Ph.D.
Backup ContactHåkan Wallén, M.D., Prof.
Outcome results
None listed